Provider Demographics
NPI:1164401451
Name:MEDICAL ACUPUNCTURE OF NORTHERN COLORADO, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:MEDICAL ACUPUNCTURE OF NORTHERN COLORADO, PROFESSIONAL LLC
Other - Org Name:MEDICAL ASSOCIATES OF NORTHERN COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-482-7800
Mailing Address - Street 1:1217 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3218
Mailing Address - Country:US
Mailing Address - Phone:970-482-7800
Mailing Address - Fax:970-482-7802
Practice Address - Street 1:1217 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3218
Practice Address - Country:US
Practice Address - Phone:970-482-7800
Practice Address - Fax:970-482-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47329866Medicaid
COC801041Medicare PIN